title: Antiplatelet and antithrombotic treatment after transcatheter aortic valve implantation - comparison of regimes.
abstract: OBJECTIVE
  We compared procedural and follow-up complications of TAVI patients based on the type of antithrombotic treatment used (single-antiplatelet [SAPT] vs dual-antiplatelet [DAPT] vs warfarin).
  
  
  BACKGROUND
  Despite growing operator experience and device development, vascular complications following transcatheter aortic valve implantation (TAVI) remain problematic. Bleeding complications and stroke are two of the main disadvantages compared with surgical aortic valve replacement. Correct choice of antiplatelet or antithrombotic treatment is therefore crucial, but remains empirical.
  
  
  METHODS
  We analyzed a cohort of 171 patients with symptomatic severe aortic stenosis who underwent TAVI using the CoreValve (Medtronic, Inc) in our center between December 2007 and June 2012. We assessed both procedural, in-hospital, and follow-up outcomes for vascular complications, stroke, myocardial infarction, bleeding complications, and death.
  
  
  RESULTS
  Patients were aged 81.6 ± 6.4 years; 47% were male. Treatment regimes were DAPT (34%), SAPT (53%), or warfarin (13%). When analyzing the combined endpoint of all-cause death, acute coronary events, stroke, or bleeding, the outcome was significantly worse in the DAPT group (in-hospital P=.01, 30-day follow-up P=.02). This difference was driven mainly by bleeding complications, with a trend toward higher rates of major bleeding events in the DAPT group vs SAPT group (P=.07 for both in-hospital and 30-day bleeding). The occurrence of major adverse cardiac and cerebrovascular events was statistically similar in all groups.
  
  
  CONCLUSIONS
  This relatively small series suggests that DAPT does not protect patients from stroke, but may expose them to higher bleeding risk. Further study of this area is warranted.
authors.affiliation: Sussex Cardiac Centre, Eastern Road, BN2 5BE, Brighton, United Kingdom. david.hildick-smith@bsuh.nhs.uk.
authors.forename: Petra
authors.initials: P
authors.lastname: Poliacikova
authors.forename: James
authors.initials: J
authors.lastname: Cockburn
authors.forename: Adam
authors.initials: A
authors.lastname: de Belder
authors.forename: Uday
authors.initials: U
authors.lastname: Trivedi
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization; D004305:Dose-Response Relationship, Drug; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D013927:Thrombosis / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors